Provider Demographics
NPI:1841748167
Name:RIVERA, VIVIANA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:VIVIANA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:VIVIANA
Other - Middle Name:
Other - Last Name:TRETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 S GARY AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2228
Mailing Address - Country:US
Mailing Address - Phone:630-893-5230
Mailing Address - Fax:
Practice Address - Street 1:245 S GARY AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2228
Practice Address - Country:US
Practice Address - Phone:630-893-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily